Individual
MISS KORAN BIANCA WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21 S 11TH ST, PHILADELPHIA, PA 19107-4223
(267) 209-3245
(267) 907-8591
Mailing address
21 S 11TH ST, PHILADELPHIA, PA 19107-4223
(267) 209-3245
(267) 907-8591
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN0006020
PA
133V00000X
Registered Dietitian
DN006020
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN006020
PA NURSING BROAD
PA
Enumeration date
01/02/2020
Last updated
08/12/2022
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